Table 1.

Summary of included studies.

Reference/intervention	Study type	Number of			Follow-up		Outcomes
		Patients	Hips	Graf D/II/IV)	Duration	Loss to follow-up	Primary	Secondary	Complications
PICO 1: Pavlik harness vs other abduction devices
Zidka et al. (14)	RCCS
Pavlik harness		137		48	119 days	16 patients (14%)	Graf I ultrasound: 100%
Frejka pillow		145		26	95 days	7 patients (5%)	Graf I ultrasound: 100%
Wilkinson et al. (15)	RCCS				6–12 months	0%			None
(i) Craig splint			28					Spica cast: 3 hips (10.7%); Operation: 1 hip (3.6%)
(ii) Pavlik harness			43					Spica cast: 10 hips (23.3%); Operation: 3 hips (7%)
(iii) Von Rosen splint			26					Spica cast: 0; Operation: 0
No splint			37					Spica cast: 8 hips (21.6%); Operation: 2 hips (5.4%)
Atar et al. (16)	RCCS
Pavlik harness		40	48		1.8 years (1–5)	0%	Successful reduction: 42/48 (88%)		AVN 3/48 (6%)
Frejka splint		70	84		1.5 (1–4) 0%	0%	Successful reduction: 76/84 (90%)		AVN 6/84 (7%)
PICO 2: Closed reduction restricted by limited hip abduction – traction vs adductor tenotomy
Carney et al. (17)	RCRS
Traction		2			91 months (24–163)	N/A	Successful reduction: 100%	Residual dysplasia 2/2 (100%)	AVN 1/2 (50%)
Adductor longus tenotomy		8					Successful reduction: 100%	Residual dysplasia 6/8 (75%)	AVN 2/8 (25%)
Closed reduction without traction or tenotomy		5					Successful reduction: 100%	Residual dysplasia 5/5 (100%)	AVN 3/9 (33%)
Both traction and tenotomy		5					Successful reduction: 100%	Residual dysplasia 2/5 (40%)	AVN 2/5 (40%)
PICO 3: Unsuccessful closed reduction – surgical reduction through a medial or anterior approach vs other surgical approaches
Duman et al. (18)	RCCS								AVN and femoral neuropathy
Arthroscopic-assisted		26	26		24 months (24–30)	4	Successful reduction: 26/26; Successful functional outcome (MacKay score): 18 (81.8%); AI: 27° (19–36);	Blood loss: 9 mL (5–15); Operative time: 32 min (30–40)	0
Medial approach (Ludloff)		28	28				Successful reduction: 27/28; Successful functional outcome (MacKay score): 17 (80.9%); AI: 26° (11–39);	Blood loss: 35 mL (15–55); Operative time: 34 min (30–40)	0
Yorgancigil et al. (19)	RCCS						Successful functional outcome (MacKay)(P = 0.23); AI postoperative P   = 0.226	Revision surgery (P = 0.170)	AVN and femoral neuropathy (P= 0.933)
Anterior approach		17	22		84.0 ± 29.5 months	NR	18 hips (81.8%); AI postoperative: 21.23° ± 3.70	4 hips (18.1%)	5 hips (22.7%)
Medial approach		19	21		75.2 ± 19.6 months	NR	17 hips (80.9%); AI postoperative: 21.86° ± 3.93	3 hips (14.3%)	5 hips (23.8%)
Hoellwarth et al. (20)	RCCS						AI, mean (P = 0.23)	Revision surgery (P = 0.48)	AVN and femoral neuropathy), P= 0.32
Anterior approach		18	19		6.2 ± 3.2 months	NR; Incomplete data: 22	17° (6–25)	7 hips (37%)	10 hips (53%)
Medially based approach		14	19		6.1 ± 2.8 months	NR; Incomplete data: 2	19° (11–33)	4 hips (21%)	6 hips (32%)
Holman et al. (21)	RCCS						Successful reduction		AVN, femoral neuropathy and osteonecrosis
Anterior approach			141 for surgery; 48 in follow-up study		27 years (13–54)	96 hips	9 (19%) re-dislocations	20 hips (42%)	9 hips (18.8%)
Medial approach Ludloff			38 for surgery; 18 in follow-up study			20 hips	2 (11%) re-dislocations	9 hips (50 %)	1 hip (6 %)
Tarasolli et al. (22)	PCS						Successful reduction	Acetabular index (P= 0.18)	AVN, femoral neuropathy, and osteonecrosis (P = 0.52)
Anterior approach		21	22		61 months (28–100)	1	0 re-dislocations	Absolute mean: 24° (15°–34°)Mean decrease: 7.9° (6°–10°)	4 (18%)
Medial approach		22	26		77 months (26–228)	0	1 (4%) re-dislocations	Absolute mean: 25° (16°–35°)Mean decrease: 8.8° (4°–12°)	3 (12%)
Matsushita et al. (23)	RCCS				11–14 months	NR	Successful functional outcome (MacKay),	Due to (sub)luxation	AVN, femoral neuropathy, and osteonecrosis
Wide exposure method		27	32				24 (77.4%); Residual dysplasia: 4 hips (12.9%) class III, 1 hip (3.2%) class IV	0	1 hip (3.2%)
Medial approach		24	31				24 (75%); Residual dysplasia: 11 hips (34.4%) class III, 3 hips (9.4%) class IV; P<0.05	10 hips (31.3%)	7 hips (21.9%)
PICO 4: After successful surgical reduction (closed or open) – short period of spica cast treatment compared vs longer period
Emara et al. (26)	RCCS				±12 years	NR	Clinical assessments according to McKay criteria (P = 0.612)	Radiographic assessment according to Severin classification (P = 0.449)
Spica removed after 4 weeks followed by abduction brace		32	38				E = 81.6%, G= 18.4%	Ia= 81.6%, Ib =15.8%	AVN: 15.8%; (P = 0.015); Other: 0 hips
Spica removed after 12 weeks, then started ambulation without brace		24	29				E = 86.2%, G= 13.8%	Ia = 69%, Ib = 24.1%, II = 6.9%	AVN: 48.3%; Other: 5 hips; (P = 0.029)

AI, acetabular index; PCS, prospective cohort study; RCCS, retrospective comparative cohort study; RCRS, retrospective chart review study.